Priorities for obesity prevention research

Barry Popkin

University of North Carolina, Chapel Hill, Estados Unidos de América

Introduction/objectives: To describe the major research gaps
as related to prevention of childhood obesity in Latin America.
Development: We focus on some unique research challenges
in Latin America and propose a research agenda tailored
to needs and opportunities for guiding progress in obesity
prevention and control in the Latin America region. (We do
not address obesity treatment, which in itself is another major
global issue.) We address these needs in relation to five major
clusters: (1) the growth process and lifecycle and within
this the relative importance of food, beverage, and activity
patterns specific to this region; (2) the major direct and underlying
drivers of dietary and physical activity/inactivity
patterns including current food and physical activity environments;
(3) the quality of current surveillance and measurement
and the major gaps; (4) the efficacious interventions
for behavioral change; and (5) the policy arena, the current
options underway and their evaluation and potential future
options. In so doing, we intend to signal adequate windows
of research opportunity to contribute to broader, evidencebased
childhood obesity prevention in Latin America, an
approach that will require both cross-disciplinary research
and renewed innovative capacity building efforts in the region
and the connection of evidence (research) to policy and
practice. First, Latin America is further along the nutritional
transition than other LMIC regions, having reduced undernutrition
with a few exceptions, and now facing high levels
of overweight, obesity, and related NCDs in most countries.
Many Latin American children are getting taller, but they are
also becoming fatter, simultaneous shifts that have been well
documented in population-wide profiles in that include both
distributions of height (length)-for-age and weight relative
to height (length). The existence of, transition to, and prevention
of current double or triple burdens of malnutrition,
as well as their determinants, have important research and
programmatic implications, and suggest a need to move from
targeted projects focused directly on under-nutrition mainly
during the first 1000 days of life to more population-wide
programs focusing more broadly on diet quality and activity
throughout the life course as they relate to obesity prevention
and health promotion. A second and related distinguishing
factor for the Latin American region is that the region has faced,
earlier than other regions and at higher velocities, major
international migration to the United States and internal urbanization.
This rapid urbanization- which has been accompanied
by the significant entry of major processed, packaged
food and beverage companies, increased “fast” and processed
food availability, a decrease in fresh food availability, and a
lack of space for physical activity- has negatively impacted
the health and weight of populations. A third unique characteristic
of Latin America is the stronger collective nature
of government policies adopted to control obesity. The Latin
American region has emerged as a leader in addressing
environmental factors that impact diet and activity patterns;
however, rigorous evaluations of many major initiatives (e.g.,
Brazilian school feeding changes, ciclovia) are lacking and
all the new large-scale regulatory initiatives require serious
evaluations. A fourth characteristic that is not unique to the
region, but is worthy of mention, is that Latin America is not
comprised of a homogenous ethnic group. Conclusions: Latin
America possesses strong research groups, but there are
major gaps in the research as it relates to obesity and its key
determinants and options for prevention. Key gaps exist in
many countries on dietary and physical activity patterns and
trends. Across the region for various age-gender-race-ethnic
subpopulations there is a lack of understand of key diet and
activity pattern determinants as well as minimal rigorous
evaluation of many large-scale regulatory interventions for
which the region is a global leader. Key words: child obesity,
food system, diet, physical activity, research gaps.